Scaling your aligner practice: offer a real alternative to direct-to-consumer aligners

Aalok Shukla explains how dental practices can compete with direct-to-consumer aligner companies, and grow their aligner business.

Invisible aligners are one of the most demanded cosmetic procedures. This is the reason behind it becoming one of the fastest growing segments in dentistry. But you may not be starting as many cases as you would like to.

If you search your practice email inbox for the keywords ‘aligner cost’ or ‘braces price’, it may shock you at how many emails you receive when you compare this against how many cases you start.

In this article we will explain how you can make a simple shift to introduce a parallel and technologically enhanced solution to dramatically increase your number of aligner cases without increasing your chair time.

direct-to-consumer aligners

Demand for invisible aligners

There are three main factors fuelling the demand for invisible aligners.

Patient demand

More people than ever before are looking at their smile in photos, videos, social media and Zoom calls.

This enhanced awareness and elevated importance of the smile being 30% or more of our digital presence on screen has led more people to want straighter teeth as an adult.

It means they are paying for the solution themselves. And they do not want a visible metal solution for themselves.

This makes invisible aligners the most popular choice. They are removable and discreet, so nobody you don’t want to know, won’t know.

Dentist preference

As time has evolved, dentists have looked for solutions that require less chairtime and deliver higher impact.

The main constraint in a dental practice is the chairtime and dentist time. So each hour needs selling for as much as possible.

Fixed braces require regular monthly adjustments and present with emergencies in the form of debonded brackets and broken wires.

During the Covid pandemic, many dentists were closed and this presented an issue for the monthly brace adjustments. It was during this time that more dentists established a preference for aligners as a solution that was more pandemic proof. And it could continue without all the chairtime requirements of fixed braces.

The emergence of direct to consumer companies

They offer aligners direct to the patient for a fraction of in-clinic prices.

These companies and smile clubs have applied modern digital marketing with a lower cost structure. They often offer aligners to patients for 50% to 70% cheaper than in-clinic prices.

These solutions also come with less friction. There are no attachments on the teeth and if they provide any support it is online based.

Many of these companies have also opened high street shop locations offering free 3D scans. This is leading to the mass market awareness of this aligner solution.

The combination of these three factors is leading to a surge in awareness for aligners. And an unprecedented number of patients looking for them as a solution.

This is why practices are receiving more email enquiries than ever before. But there is a problem; 80-90% of enquiries are not progressing to treatment with the clinic. Let’s look at why.

Demand for orthodontics

In the UK we can see that 25,000-50,000 adults have the budget to pay £3,000+ for comprehensive orthodontics. They have the willingness to have attachments placed on their teeth and attend frequent appointments.

This is because they are highly invested in improving their smile. They perceive their issues as meaningful to them.

This price point and willingness for advanced procedures and ongoing appointments puts the solution on par with laser eye surgery. It’s the same price bracket and the ‘gold standard’ solution.

There are however 500,000 to 1 million adults that want to improve their smile with a more ‘contact lens’-type solution versus the laser eye surgery option.

These patients would go ahead at a price closer to £1,650 with a removable aligner solution without attachments. And with a hybrid approach with mainly virtual visits for monthly check-ins.

These are the patients we are talking about here.

Laser eye surgery

To give a guideline of how this market is evolving as a comparison let’s look at a comparable industry:

  • 70% of adults need vision correction in the UK, which matches with the 70% of adults who have crooked teeth.
  • 8% of adults wear contact lenses – 3.2million
  • 0.25% of adults choose laser eye surgery – <20,000.

Compare and remember those two numbers; <20,000 people choosing laser eye surgery versus 3.2million choosing contact lenses.

In our previous article we talked about the model of virtually monitored aligners. This is where the practice can provide aligners with a minimum of chairtime – such as three 10-minute appointments and 10 three-minute virtual visits.

This means the practice can offer an affordable accessible solution that is better than the direct-to-consumer smile clubs at a comparable price.

An example of this is where the dentist gets to provide affordable cosmetic teeth straightening in a scalable way.

Maximising aligner cases

So, let’s look at the model a practice should adopt in order to maximise aligner cases.

As we have discussed there is a huge demand for aligner treatment. Patients are looking for two types of solution – the ‘laser eye surgery’ option, but then there are 20 times more people looking for the ‘contact lens’ option.

So, if we look at dental practices, they are increasingly getting enquiries for aligners that are focused on the contact lens enquiry. This means they have milder/moderate crowding and their concerns are purely cosmetic.

One of the things we have noticed statistically is that clinics that start five aligner cases a month usually present eight treatment plans. This means they schedule 10 appointments, which mean there are 50 enquiries about teeth straightening.

This equates to 45/50 – 90% of enquiries are not going ahead with treatment. These are the people that end up going to the smile clubs for an affordable option.

This is why one of the biggest things a practice can do to boost the number of aligner starts. Offer a technologically advanced ‘contact lens’ solution alongside the ‘laser eye’ comprehensive orthodontics solution.

Comparing options

Once this is introduced, you should offer the patient two options:

  • Comprehensive orthodontics (laser eye surgery) with aligners, attachments, lots of visits
  • Cosmetic orthodontics (contact lenses) – zero attachments, 90% virtual visits for 50% of the cost.

This means the first inflection point is to change how your practice answers to emails and social enquiries asking how much aligners cost.

Instead of simply quoting the ‘laser eye price’ of £3,000+, there should be an answer about how complete solutions are available from £1,650. And there should be an email reply that offers to add additional value, such as offering the patient a personalised smile assessment report, which you can do through platforms such as Instant Dentist.

This model of offering a digital front door and a way to communicate a compelling solution of affordable aligners with the convenience of an initial online experience, the price of online providers but the trust and convenience of a local dentist, yields a much stronger value proposition. Especially once combined with advanced monitoring, such as through the Dental Scope with Virtuoso Aligners.

The use of this can help patients understand more about their oral health. They are more likely to choose additional procedures such as white fillings, teeth whitening, cosmetic bonding and more hygiene visits as a result of seeing inside their mouth.

This also adds a family dimension. Other family members can use the protective covering to access digital assessments from your practice (using a separate digital dental health consult system that is included with the platform for practice growth).

Doubling uptake

From studies we have done we can see this simple shift in email reply. Receiving a personalised report about their smile from their e-consultation can demonstrate trust and boost patients wanting to come in by close to double the original figure.

This means 20 visits scheduled versus 10.

When these patients come in, the ability to use the power of demonstration and technology to show an advanced cosmetic solution alongside the higher-priced laser solution means patients get the best of both worlds.

It means that patients are more likely to choose one solution from the clinic over a direct-to-consumer company.

By putting together a detailed treatment plan, the patient can gain the trust and expertise of what you are doing and delivering. And when they choose to go ahead, the key to a smooth scalable journey without consuming chairtime is to involve your team in the monthly digital monitoring process. Your team can prompt the patient to complete their review and also pre-schedule the next virtual reviews and the three 10-minute physical visits.

These monthly reviews are digital check-ins and don’t require any video calls. This means your practice is now getting payment for digital monitoring services. And you reduce the amount of chairtime you need to schedule.

This is a hybrid model of delivery. You can of course schedule more chairtime if you wish. But the core point here is by using a technologically-assisted model, you need less chairtime. So you can maintain a very high hourly rate of >£700/hour. Even whilst offering a very affordable price.

Growing your patients through referrals

Think of these packages as staged cosmetic smile makeovers. You can combine the aligners, then add a digital prevention plan including hygiene visits as an additional solution. Plus whitening and cosmetic bonding. And then a retainer membership plan where they subscribe for new retainers and receive them every six months.

All in, this nearly doubles the lifetime value of the patient. It makes it equivalent to the initial higher priced package.

This gives your practice two things. It gives you access to two/three times the number of patients through a much more accessible and affordable offer. And it also keeps the patient lifetime value high.

So as an example, adding 100 of these patients means you add another £300,000 or so over the next 18 months.

This model of being more accessible also translates into increased referrals.

Through this digital model, existing patients can share introduction cards with their friends. These cards invite them to do a free e-consultation and there is a bonus offer, like free teeth whitening, for the friend and the same or an alternative bonus for the existing patient.

These digitally-assisted referrals really start to compound. The more patients you straighten smiles using aligners for, the more patients will seek you out as referrals, friends, colleagues and relatives.

The best way to create critical mass is to ‘hello’ as many people as you can.

If you want to learn more about how to incorporate this model into your practice so you can stop losing aligner enquiries, than reach out at [email protected] or at

You can also view more information at

Or see our webinar ‘Secrets to starting more aligner cases‘ on

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